Seven Common Sports Injuries

Runner's Knee

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About one-fourth of all problems treated by orthopedic surgeons involve the knee, according to the American Academy of Orthopaedic Surgeons. Torn ligaments and cartilage are the bulk of the problems, but many knee ailments are lumped under the term "runner's knee," a loose heading for aches and pains involving the kneecap.

Runner's knee, which can strike cyclists, swimmers, basketball and volleyball players, step-aerobics fans, and runners, happens when the tendon below the kneecap becomes irritated from overuse or there is wear or arthritis under the kneecap. Sometimes, in knock-kneed people, leg muscles pull the kneecap out of the groove in which it normally slides up and down, causing painful grating on the cartilage. Flat-footedness also can cause kneecap displacement during exercise.

Prevention and Treatment Tips

Preventing runner's knee often involves simply replacing your worn-out shoes or insoles, which helps reduce impact. Switching from a hard to a soft running surface -- or from a hilly to a flat route -- also may relieve symptoms. Ask your doctor about shoe inserts called orthotics, which lift your arches and help position your feet so impact doesn't lead to misalignment at the kneecaps.

To help hold your kneecap in line, strengthen your quadriceps, the front thigh muscles. Getting more rest and cross-training can also help prevent overusing one set of muscles. A tried-and-true rule in sports medicine may help you avoid doing too much too soon. The "10 percent rule" says to increase the frequency, duration, and intensity of an activity by only 10 percent per week. So, if you start walking 10 miles the first week, you would walk no more than 11 miles the second week.

If you get a bad case of runner's knee, take two days off and anti-inflammatory medication, such as ibuprofen. After two days, be sure to warm up and cool down and to ice your knee for 20 minutes after the workout.

Strengthening and stretching the muscle is key, says Lewis G. Maharam, M.D., a New York City sports medicine specialist. He recommends using a weight machine to do leg extensions, concentrating on the last 30 degrees of the extension. This isolates the thigh muscles that help hold the kneecap in line. "Within eight weeks of doing this exercise regularly, runner's knee is pretty much under control," he says.

Note: Women are especially vulnerable to ligament injuries and other knee disorders. A study by Edward Wojtys, M.D., of the University of Michigan Medical School, found that female athletes had more knee laxity, less muscle strength and endurance, and different muscle reaction time than male athletes, even when strength was corrected for body weight. These factors have contributed to a large rise in women's knee injuries, two to eight times the level found in male athletes.

Ankle Sprain

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What longtime basketball, volleyball, soccer, or hockey player or runner hasn't twisted an ankle and torn a ligament or tendon? "In my practice, ankle sprains are the most common injury," says Dr. Maharam. Ankle sprains account for one in five sports-related injuries, reports the American Orthopaedic Foot and Ankle Society.

Prevention and treatment tips:

Strengthening exercises, such as heel lifts on stairs, can help prevent some sprains. Taping a weak ankle and wearing high-tops and a lace-up ankle brace also may prevent injuries, but only some. (A lace-up brace is good because you can retighten it during exercise.) The fact is, when you come down hard and wrong on a foot, forces are often too great for tape and high-tops.

Treatment of ankle sprains involves RICE, an acronym for rest, ice, compression, and elevation. Place your ankle up on a chair while you ice it for 20 minutes, three times a day. Then wrap it with an elastic bandage and keep it elevated. When you're icing, Dr. Maharam advises putting ice in a sealable bag with water so your skin doesn't freeze. He also advises having the ankle X-rayed to rule out possible fractures and chipped bones.

Rest should only be for about a day. Gently putting the injured area in motion, says Dr. Maharam, helps promote healing by circulating "dead" blood out, which also reduces swelling. Dr. Maharam tells his patients to sit in a chair and cross their legs so the injured ankle is off the floor. With the big toe on the injured foot, trace imaginary letters from A to Z.

Shinsplints

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"Shinsplints" is a general term used to describe pain on the inner side of the middle third of the shinbone. Shinsplints can be caused by running or jumping on hard surfaces, wearing worn-out shoes, or increasing intensity too fast while training.

The shinbone is the attachment site for muscles used to help raise the arch of the foot. Insufficient arch support or too-tight calf muscles strain these arch-raising muscles and the attached tendons, causing mild to sharp pain. Shinsplints often occur in people who aren't used to exercise, says Robert Nirschl, M.D., of the Nirschl Orthopedic Clinic at Arlington Hospital in Arlington, Virginia.

Prevention and treatment tips:

Wear good shoes with solid arch support.

Use the "10 percent rule" so you don't increase training too fast: Increase the frequency, duration, and intensity of an activity by only 10 percent per week. (Example: If you start walking 10 miles the first week, walk no more than 11 miles the second week.)

Other ideas: cross-training, putting ice on the affected area, using orthotics, applying anti-inflammatories, and strengthening and stretching of lower leg muscles.

Pulled Muscle

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While you can tear any muscle tissue during exercise, the most common pulls are to the hamstring, calf (especially in aging tennis players), and groin muscles. Most are caused by weakness, fatigue, inflexibility, or a hasty and improper warm-up.

Prevention and treatment tips:

Take time to warm up thoroughly before you start to exercise. This will stretch your muscles.

Don't play, run, or work out to the point of exhaustion. Take it a little easier on days you feel tired; if you don't want to compromise your workout, do a gentler routine for a longer period of time.

Low Back Pain

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The good news here is that low back pain is less prevalent among people who exercise regularly. It is a far more serious problem among overweight, sedentary people. Dr. DiNubile cites a study that showed fewer back problems among firefighters as they improved their aerobic fitness.

Low back pain, however, is always lurking around the corner for golfers, tennis players, cyclists, joggers, and baseball and softball players. One hurried warm-up before the first tee can bring any golfer to his or her knees with a backache.

Usually, the problem is the sudden overloading of muscles and ligaments that aren't warmed up or strong or flexible enough to withstand the activity. Back spasms, bulging discs, and sciatica (pain shooting down the leg from the lower back) are less common but more painful.

Runners may be surprised to know their low back pain is usually not related to the above causes. "The most common cause of low back pain in runners is a leg-length discrepancy," says Dr. Maharam, author of Backs in Motion. Repeated and jarring movement with one leg 1/4 inch longer than the other throws the back out of whack.

Prevention and treatment tips:

Treatment depends on the injury. A bulging disc and sciatica require immediate medical attention. Leg-length discrepancies are often solved by using orthotic lifts designed by a podiatrist. Back spasms and muscle pulls respond to RICE (rest, ice, compression, and elevation), anti-inflammatory medication, and a stretching and strengthening program. (For more about RICE, see the "Ankle Injuries" page.)

To keep low back pain at bay, learn about proper standing and sitting posture and lifting techniques. Also, check with your doctor about the scores of good exercises that increase back muscle strength and flexibility as well as abdominal muscle strength. Abs support the back muscles; if the abs are weak, the back muscles become overstrained.

Here's a simple exercise from Dr. DiNubile that builds the back extensor muscles (the long thin bands that run the length of the backbone and are often sore from exercise). Get on all fours. Raise one arm so that it's straight out from your shoulder, parallel to the floor. Extend the opposite leg so it's also parallel to the floor. Hold for 10 to 20 seconds. Repeat using the other arm and opposite leg. Then lie on your stomach and extend both hands and feet as if you were flying. Hold for 10 seconds.

Shoulder Pain

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About 4 million people seek medical help each year for shoulder sprains, strains, and dislocations. Shoulder pain is common in sports that involve excessive overhead motion, such as swimming, tennis, weight training, volleyball, baseball, and softball. Early in the season, too many innings of softball can be hard on winter-softened shoulders.

Most shoulder problems are from overuse. The shoulder is a ball-and-socket joint held together by a group of muscles and tendons called the rotator cuff. Repeated use loosens the rotator cuff, and you feel stiffness, a lack of strength, and slipping in the shoulder, especially as you raise your arm overhead. Impingement is the pain caused by excessive rubbing of the rotator cuff on the top part of the shoulder blade.

Prevention and treatment tips:

RICE (rest, rice, compression, and elevation), and anti-inflammatory medication help shoulder pain. (For more about RICE, see the "Ankle Injuries" page.)

The best treatment is also the best prevention: exercises to strengthen shoulder muscles.

Tennis or Golf Elbow

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When the tendons and muscles on the outside of your elbow are repeatedly overloaded in the backhand stroke in tennis, the result is a tendon degeneration called tennis elbow.

Golf elbow occurs when poor strokes result in jarring divots and when golfers try to "muscle the ball," says Dr. Nirschl, author of Arm Care. Golf elbow can occur on either elbow -- on the outside of the leading elbow (the left arm for right-handers) or the inside of the trailing elbow (the right arm).

Prevention and treatment tips:

RICE (rest, ice, compression, and elevation) and anti-inflammatory medication are routinely prescribed with these elbow ailments. (For more about RICE, see the "Ankle Injuries" page.) But pills and rest don't heal the tissue, says Dr. Nirschl. "They are temporary comforters, not a cure," he says.

Equipment adjustments are important in tennis elbow. Dr. Nirschl recommends using a racket of medium flexibility and somewhat loose string tension. Also, try a larger grip; a too-small grip may cause you to squeeze the racket too hard, which causes strain.

Elbow braces also can help in preventing a stranglehold grip and in dampening the impact forces that travel from the racket up your arm. "Even when I go to the hardware store I look for a hammer that fits my hand," Dr. Nirschl says. "The employees kind of look at me like I'm nuts."

But the best help for tennis or golf elbow doesn't come from a doctor. He or she can't advise you in tennis, for example, about too much topspin and late hits with bent-elbow backhands. Bad technique brings about bad elbows no matter what medical advice you receive, says Dr. DiNubile. "I tell some of my patients that they'd do better taking lessons from a tennis pro than to keep coming back to me."